神经心理发育障碍儿童静态眼睛照片深度学习的病例对照初步研究

背景：目前对儿童神经心理发育障碍的诊断主要靠临床表现，尚缺乏客观的生物学指标，一些神经心理发育障碍儿童的眼睛特征可能具有重要的临床价值。 目的：评价静态眼睛图像是否可以作为儿童神经心理发育障碍的一个潜在的筛查测试。 设计：病例对照研究。 方法：双眼图像采集应用Google人脸图片搜索引擎进行图片搜索，以“autism and child/autistic child”和“normal child/healthy child”关键词搜索到的图片分别归为神经心理发育障碍组和对照组。人工删除完全重复的照片、卡通照片、有面部畸形的照片、没有儿童脸的照片和有多个儿童脸部的照片；应用图像工具识别和挖取每张儿童人脸照片中的双眼图像。生成的眼睛图像调整至128×28分辨率(8位灰度)。卷积神经网络（CNN）是基于一台安装了Kera、Scipy和Python成像库(PIL)的Windows 7计算机。采用二进制交叉熵损失函数和RMSprop算法优化器对模型进行训练。将图像数据分为训练集、验证集和测试集。神经心理发育障碍组测试分数>0.5为分类正确，对照组≤0.5为分类正确，训练25次停止。以分组检索结果为“金标准”，以深度学习训练模型分组为待测标准。计算准确率和损失率。 主要结局指标：根据深度学习训练模型两组特征生成的眼睛图像。 结果：通过双眼图像采集到826张儿童眼睛图像，神经心理发育障碍组413张，对照组413张。训练集736张（89.1%），验证集44张（5.3%），测试集46张（5.6%）。训练集和验证集准确率随训练次数增加呈升高趋势，训练集和验证集损失率随训练次数增加而逐渐下降。神经心理发育障碍组和对照组测试分数分别为0.66±0.20和0.20±0.15，差异有统计学意义（t=9.03，P<0.001），正确分类例数分别为18/23例(78.3%)和22/23例(95.6%)。准确率为87.0%，敏感度为78.3%（95%CI：58.1%~90.3%），特异度为95.6%（95%CI：79.0%~99.2%）。深度学习训练模型ROC曲线显示，AUC=0.962。由CNN卷积图层的可视化生成神经心理发育障碍组和对照组的眼间距宽，像素数分别为90和70。 结论：深度学习训练模型可以获得神经心理发育障碍儿童的眼睛特征，这将有利于通过评价眼睛图片提高儿童神经心理发育障碍的早期筛查水平。     

Deficient orthographic and phonological representations in children with dyslexia revealed by brain activation patterns

BACKGROUND: The current study examined the neuro-cognitive network of visual word rhyming judgment in 14 children with dyslexia and 14 age-matched control children (8- to 14-year-olds) using functional magnetic resonance imaging (fMRI). METHODS: In order to manipulate the difficulty of mapping orthography to phonology, we used conflicting and non-conflicting trials. The words in conflicting trials either had similar orthography but different phonology (e.g., pint-mint) or similar phonology but different orthography (e.g., jazz-has). The words in non-conflicting trials had similar orthography and phonology (e.g., gate-hate) or different orthography and phonology (e.g., press-list). RESULTS: There were no differences in brain activation between the controls and children with dyslexia in the easier non-conflicting trials. However, the children with dyslexia showed less activation than the controls in left inferior frontal gyrus (BA 45/44/47/9), left inferior parietal lobule (BA 40), left inferior temporal gyrus/fusiform gyrus (BA 20/37) and left middle temporal gyrus (BA 21) for the more difficult conflicting trials. For the direct comparison of conflicting minus non-conflicting trials, controls showed greater activation than children with dyslexia in left inferior frontal gyrus (BA 9/45/46) and medial frontal gyrus (BA 8). Children with dyslexia did not show greater activation than controls for any comparison. CONCLUSIONS: Reduced activation in these regions suggests that children with dyslexia have deficient orthographic representations in ventral temporal cortex as well as deficits in mapping between orthographic and phonological representations in inferior parietal cortex. The greater activation for the controls in inferior frontal gyrus could reflect more effective top-down modulation of posterior representations.     

Continuous glucose monitoring for hypoglycaemia in children: Perspectives in 2020

Hypoglycaemia in children is a major risk factor for adverse neurodevelopment with rates as high as 50% in hyperinsulinaemic hypoglycaemia (HH). A key part of management relies upon timely identification and treatment of hypoglycaemia. The current standard of care for glucose monitoring is by infrequent fingerprick plasma glucose testing but this carries a high risk of missed hypoglycaemia identification. High‐frequency Continuous Glucose Monitoring (CGM) offers an attractive alternative for glucose trend monitoring and glycaemic phenotyping but its utility remains largely unestablished in disorders of hypoglycaemia. Attempts to determine accuracy through correlation with plasma glucose measurements using conventional methods such as Mean Absolute Relative Difference (MARD) overestimate accuracy at hypoglycaemia. The inaccuracy of CGM in true hypoglycaemia is amplified by calibration algorithms that prioritize hyperglycaemia over hypoglycaemia with minimal objective evidence of efficacy in HH. Conversely, alternative algorithm design has significant potential for predicting hypoglycaemia to prevent neuroglycopaenia and consequent brain dysfunction in childhood disorders. Delays in the detection of hypoglycaemia, alarm fatigue, device calibration and current high cost are all barriers to the wider adoption of CGM in disorders of hypoglycaemia. However, machine learning, artificial intelligence and other computer‐generated algorithms now offer significant potential for further improvement in CGM device technology and widespread application in childhood hypoglycaemia.     

Training clinicians to care for children in emergency departments

Children account for 22% of presentations to Emergency Departments in Australia, the majority presenting to mixed departments. A diverse group of clinicians looks after these children. In this review, we examine the different techniques and approaches to implementing education curricula and professional development within these emergency departments with a particular focus on bedside teaching, professional coaching, skills maintenance, e‐learning and simulation.     

Occasional review: assessment of pain in non-communicative children

Pain is a common experience in non-communicative children with significant learning disabilities and may be an important cause of challenging, including self-injurious, behaviour. Important causes of pain include gastro-intestinal, dental and orthopaedic problems. It is difficult for these children to self-report pain and research is ongoing into schemes to aid self-report. A number of observational pain assessment tools have been developed over recent years and these may facilitate a more accurate assessment of pain, but again more research is needed. Paediatricians are well placed to provide appropriate investigation and management of conditions causing pain in this vulnerable group of children.     

Language and phonological skills in children at high risk of reading difficulties

BACKGROUND: Dyslexia is now generally acknowledged to involve difficulties in phonological processing. However, the links between reading difficulties and speech difficulties remain unclear. METHOD: In the present study, 17 children with speech difficulties between the ages of four and six were compared to children with a family history of dyslexia and normally developing controls on phonological processing, phonological learning, phonological awareness and literacy tasks. RESULTS: The two groups of children at risk of reading difficulties showed very similar patterns of impairment, with average vocabulary but poor input and output speech processing, phonological learning, phonological awareness and reading development. CONCLUSIONS: It is concluded that the antecedents of reading difficulty are similar in these two groups of children, with both groups showing deficits in the development of phonological representations.     

Educational and therapeutic resource dependency at early school-age in children who were born very preterm

AIM: To examine the incidence of educational and therapeutic resource dependency in a group of very preterm children at 8 years of age. METHODS: All children with a gestational age less than 30 weeks, who survived to discharge from the neonatal intensive care unit at Royal Prince Alfred Hospital, between 1987 and 1994, were prospectively enrolled in developmental follow-up. At 8 years of age, information regarding resource dependency was obtained from parents and teachers using interviews and questionnaires. Standardized psychometric measures of cognition and academic achievement were administered. RESULTS: Information was obtained for 365 (73.3%) of surviving 8-year-old children; 65 (17.8%) had a neurosensory disability and 24 (36.9%) children in this group were in full-time special education. In those without neurosensory disability (n=300), seven (2.3%) children were already in full-time special education for an intellectual deficit. Among children in mainstream education, 154/293 (52.5%) had received or were still receiving additional assistance in some form (part-time special education, grade retention, therapeutic intervention or private tutoring). Difficulty in literacy was the most commonly reported problem. Resource dependency was not related to gestation nor predicted by intelligence in children without neurosensory disability, but was related to maternal education. Children who had had or were continuing to receive part-time assistance showed delays in academic skills at assessment. CONCLUSIONS: A high level of on-going resource dependency exists in this group in an attempt to maintain grade appropriate achievement. Resource dependency is not related to gestation in neurologically normal children. General cognitive measures of intelligence do not predict these problems in the majority of children.     

The relationship between vocabulary, grammar, and false belief task performance in children with autistic spectrum disorders and children with moderate learning difficulties

BACKGROUND: The aim of this study was to examine the relationship between language and theory of mind in children with autistic spectrum disorders (ASD) and children with moderate learning difficulties (MLD). Previous studies have found a strong association between language and theory of mind in a range of groups, but mostly have not included measures of both grammar and vocabulary; including these enables us to speculate about the causal direction of the relationship. METHODS: Fifty-eight children with ASD and 118 children with MLD were given standardised assessments of vocabulary and grammar, along with standard theory of mind tasks. RESULTS: The relationship between language and theory of mind was more evident in children with ASD than in those with MLD, and grammar was a particularly strong predictor of theory of mind performance in children with ASD. Children with MLD performed better on false belief (FB) tasks than did children with ASD, and their performance was more predictable across the different theory of mind tasks. CONCLUSIONS: Language, in particular grammar, and theory of mind appear to be more strongly related in children with ASD than in those with MLD. We speculate that this relationship may be causal, with some grammatical understanding being a precursor of theory of mind. The implications of these findings are discussed in relation to possible routes for compensatory strategies for mentalising in children with ASD.     

Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy

ObjectiveTask-specific body-weight-supported treadmill therapy improves walking performance in children with central gait impairment. The aim of the study was to investigate the effect of robotic-assisted treadmill therapy on standing and walking performance in children and adolescents with cerebral palsy and to determine parameters influencing outcome.Methods20 Patients (mean age 11.0 ± 5.1, 10 males and 10 females) with cerebral palsy underwent 12 sessions of robotic-assisted treadmill therapy using the driven gait orthosis Lokomat. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure (GMFM).ResultsSignificant improvements in dimension D by 5.9% (±5.2, p = 0.001) and dimension E by 5.3% (±5.6, p < 0.001) of the GMFM were achieved. Improvements in the GMFM D and E were significantly greater in the mildly affected cohort (GMFCS I and II) compared to the more severely affected cohort (GMFCS III and IV). Improvement of the dimension E but not of D correlated positively with the total distance and time walked during the trial (r_s = 0.748, p < 0.001).ConclusionsChildren and adolescents with bilateral spastic cerebral palsy showed improvements in the functional tasks of standing and walking after a 3-week trial of robotic-assisted treadmill therapy. The severity of motor impairment affects the amount of the achieved improvement.     

Paediatrician's role in caring for children with learning difficulties

Aim: Children with learning difficulties are commonly seen in Australian paediatric outpatient settings. The practice patterns of paediatricians in assessing, referring and managing these children are unknown, and there is no consensus on best practice. We thus aimed to examine the consistency between Australian paediatricians': (i) assessment; (ii) referral; and (iii) management of children presenting with learning difficulties. Methods: All 373 paediatrician members of the Australian Paediatric Research Network were invited to participate in an online survey in 2010. Paediatricians who saw children with learning difficulties were asked questions about their assessment, referral and management practices. Results: Of 181 (49%) paediatricians to complete the survey, 140 (77%) reported seeing patients with learning difficulties. Most often, paediatricians supplemented their clinical assessments with audiology assessments (75%), teacher or parent questionnaires (60–65%), or teacher contact (51%). Paediatricians used medical investigations (40%), direct assessment tools (27%) or a school visit (4%) less often. Most paediatricians referred children with learning difficulties to educational psychology (84%), special education (61%) or speech therapy (66%) services but less often to occupational therapy (34%) or mental health (15%) services. The most common management strategies were to provide a report to the school (76%) or parents (66%) and to make recommendations around sleep hygiene (75%) and for tutoring (66%). Conclusions: Australian paediatric practice in this area is diverse, with the greatest variability around management practices. These data provide a case for designing and implementing evidence‐based guidelines for the paediatric care of children who struggle to learn in school.     

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory

Background:  Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue.
Methods:  Arithmetic ability was longitudinally assessed in children with cerebral palsy in special ( n  =   41) and mainstream education ( n  =   16) and controls in mainstream education ( n  =   16). Second grade executive function and working memory scores were used to predict third grade arithmetic accuracy and response time.
Results:  Children with cerebral palsy in special education were less accurate and slower than their peers on all arithmetic tests, even after controlling for IQ, whereas children with cerebral palsy in mainstream education performed as well as controls. Although the performance gap became smaller over time, it did not disappear. Children with cerebral palsy in special education showed evidence of executive function and working memory deficits in shifting, updating, visuospatial sketchpad and phonological loop (for digits, not words) whereas children with cerebral palsy in mainstream education only had a deficit in visuospatial sketchpad. Hierarchical regression revealed that, after controlling for intelligence, components of executive function and working memory explained large proportions of unique variance in arithmetic accuracy and response time and these variables were sufficient to explain group differences in simple, but not complex, arithmetic.
Conclusions:  Children with cerebral palsy are at risk for specific executive function and working memory deficits that, when present, increase the risk for arithmetic difficulties in these children.     

Safer children,healthier lives: reducing the burden of serious accidents to children

COVID-19 has placed huge pressures on clinicians and front line practitioners across the UK. The focus has been, understandably, on the day to day challenges that the pandemic has brought. But lockdown measures have also put a spotlight on safety in the home – a place where we have all spent so much more time. This is one place where there may be fewer safeguards and less protection from the risks of serious injury, especially to young children. Preventable accidental injury remains a leading cause of death and acquired disability for children in the UK. Moreover, it affects deprived children more. Hospital admission rates from unintentional injuries among the under-fives are significantly higher for children from the most deprived areas compared with those from the least deprived. To give every child the best start in life we need to create a better understanding and awareness of the injuries. To achieve this we need to prioritize learning from injury data and lived experience. We need to be linking with other partners and professionals to build strong collaborations for injury prevention. By working together and taking action we should be leading the way towards safer homes, roads and communities where children can become skilled for life, not scarred for life. This short article highlights what healthcare professionals working with children and families need to know about accidents and accident prevention in a higher income setting.     

儿童风湿性疾病引起的肝脾肿大

脾脏是最大的外周性免疫器官,与免疫功能有直接关系,T细胞与B细胞在脾脏定居,当机体受到抗原刺激时,淋巴组织增生,引起淋巴细胞、浆细胞及巨噬细胞增殖并进行免疫应答,产生抗体和大量T效应细胞而致脾脏增大。肝脏富含巨噬细胞,抗原刺激巨噬细胞增殖引起肝脏肿大。另外,某些代谢物质沉着或异常细胞浸润,临床上也可出现肝脾肿大的体征[1] 。现将常见的可引起肝脾肿大的风湿性疾病介绍如下。1　幼年特发性关节炎(juvenileidiopathicarthritis ,JIA)幼年特发性关节炎是儿科较常见的结缔组织病,根据发病6个月内的临床特征,将JIA分为全身型、…     

Radiculomyeloencephalitis caused by Angiostrongylus cantonensis in children

A case of radiculoencephalomyelitis caused by central nervous system involvement by Angiostrongylus cantonensis is reported in a 14 month-old girl. Evolution was spontaneously favourable, which is not usual in severe types. Lesions concerned the nevraxe and especially the spinal cord and are due to the migration of the larvae, creating eosinophilic inflammatory reactions.